Surgical procedures often require the use of general anesthesia rendering a patient unconscious and unable to care for himself. The operating room personnel must accordingly provide adequate care and protection of the patient's person and that responsibility is heightened because of the patient's unconscious. Specific aspects of the patient's person requiring attention are bony prominences, joints, neurovascular bundles traversing limbs, and dependent portions of the patient's body.
Some surgical procedures, for example, intra-abdominal surgery, require that only the limbs and dependent portions of the patient's back be protected. During these types of procedures, the patient is positioned once and no further positive action beyond adequate protection is required, because the patient will not be moved during the surgical procedure. Some procedures, however, particularly orthopaedic procedures, require not only initial positioning of a patient's body coupled with adequate protection, but will also involve intra-operative maneuvering and manipulation of the patient and patient's limbs.
It is during procedures involving patient manipulation, including traction, where injury to a patient's person is more likely to occur. As force is applied to a limb for traction and manipulation, some other portion of the patient must be stabilized against that traction force. The portions of the patient's body involved in exerting the traction force may be inadvertently injured if not adequately protected.
Procedures involving traction of the lower limbs are particularly fraught with potential for injury to the patient. Examples of such procedures involving traction and manipulation include total hip replacements, partial hip replacements, open reduction and internal fixation of femoral head fractures, open reduction and internal fixation of femoral neck fractures, open reduction and internal fixation of femoral trochanteric fractures, open reduction and closed reduction and internal fixation of femoral shaft fractures, and open reduction and closed reduction with internal or external fixation of tibial shaft fractures. A patient undergoing such procedures is placed on a specialized surgical support frame known as a fracture table in order to obtain the necessary traction. The patient's torso, from the pelvis and sacrum to the head, is placed on a table-like surface, with the lower extremities of the patient suspended by additional appendages extending from the surgical table or frame. The lower limb requiring the traction is placed into a traction harness and traction is applied along the axis of the limb. A pubic post extends up from the table surface to engage the patient's pelvis at the crotch in order to maintain the patient on the table and prevent the patient from being pulled off by the traction.
Considerable force is often exerted on an affected lower extremity by traction devices, and this force is transmitted to the patient's pubic and sacral area as the patient's body is pulled into the fracture table pubic post anchoring device. Unfortunately, it is not an uncommon occurrence for patients to be injured in the perineal and sacral areas by the application of the traction, with the attendant pressure applied by the pubic post. Within the perineal area, injury to the pudendal nerve, scrotum and penis of the male, labia and urethra of the female, and the ischial tuberosity of the pelvis can occur by compression or impaction of the pubic post against the patient. Injuries in the sacral area also commonly involve compression sores and skin breakdown, known as decubitus ulcers.
Surgical frames and tables have in the past been provided with protective pads. The pads, however, are shaped to fit the table surface, not the patient. Operating room personnel have, in general, been obliged to use jury-rigged padding in the form of folded or wrapped towels placed between the patient and the pubic post. As will be appreciated, towels were not intended or designed for this purpose; and the padding effect provided has been minimal. Moreover, most orthopaedic procedures using a fracture table with traction subject the patient to considerable stress, motion, and manipulation during the procedure. This motion and manipulation in conjunction with traction often times causes make shift padding to slip or fall away from its intended position, exposing the patient to considerable injury. Additionally, during the surgical procedure the patient's lower body and extremities are draped as part of the sterile technique employed by operating room personnel to minimize post-operative surgical infections. Therefore, once a patient is positioned and draped it becomes virtually impossible to reassess the patient's positioning and padding during the surgical procedure without breaking sterile technique.
A pubic post pad is available on the open market from Action Products, Inc. The Action Product pad is a gel filled square pad that is partially wrapped around a pubic post. This pad is designed to cover only a portion of the post and, if it inadvertently rotates during a surgical procedure, the patient will have no padding protection. The Action Product pubic post pad does not provide any sacral protection.
It would be advantageous to have a sacral pad and a pubic post pad designed to adequately protect the patient during all surgical procedures regardless of the degree of traction force applied, manipulation or maneuvering the patient is subjected to during the surgical procedure.